AB1406 TELERHEUMATOLOGY FOR IMPROVING FIRST ACCESS TO THE OUTPATIENT CLINIC: A PILOT PROSPECTIVE MONOCENTRIC ITALIAN STUDY
Authors: E. Giacobbe, M. C. Gerardi, N. Ughi, A. Adinolfi, M. Alqoudah, L. Belloli, C. Casu, M. Di Cicco, D. A. Filippini, C. Gagliardi, M. Muscarà, E. Verduci, O. M. Epis
Journal: Annals of the Rheumatic Diseases (2022)

Background The COVID-19 public health emergency has amplified both the potential value and the challenges with healthcare providers deploying telehealth solutions. Furthermore, outpatients may wait up to several months for their first appointment with specialists including rheumatologists for diseases other than COVID-19. In Italy it is now possible to get access to telemedicine services within the national healthcare systems, yet only follow-up visits are allowed for reimbursement purposes. Instead, it is not clear the role of telemedicine as a tool for improving first access and patient acceptance of this innovation. Objectives To investigate the feasibility of a ‘ teletriagerheum ’ service before the first visit and to identify potential benefits and disadvantages of it by comparing first face-to-face visit preceded by ‘ teletriagerheum ’ service to regular first visit without it. Methods A pilot prospective monocentric study was conducted. Consecutive patients were contacted by phone 30 days before the scheduled rheumatological first visit by administrative staff to investigate their willingness to receive 20 days before the first visit a phone call (‘ teletriagerheum ’ service) by a physician of the Rheumatology Unit. The ‘ teletriagerheum’ service aimed at investigating the reason for the visit and at prescribing additional exams or specialistic consultations before the face-to-face first visit to facilitate the diagnosis process or anticipate the appointment in case of urgency. Socio-demographic characteristics, reason for referral, face-to-face visit duration, number of additional exams prescribed, number of definite diagnosis at first visit in the ‘ teletriagerheum ’ group were compared to the ones receiving regular first visit without ‘ teletriagerheum ’ service. Results In October 2021 a total of 102 patients were phone called by administrative staff: 18 (17.6%) did not answer for a maximum of three times, 9 (8.8%) responded but refused the ‘teletriagerheum’ service (6 cancelled the visit, 1 postponed, 2 for unknown reason) and 75 (73.5%) accepted the service, but 21 were not real first visits and 8 patients did not answer the call of physician. Among the remaining 46 (45.1%) pts (the ‘teletriagerheum’ group) the median call time was 11.5 minutes (IQR 5-15 min), blood exams were prescribed to 34 (74%) and instrumental exams to 8 (17.4%). Further consultation was prescribed only to 1 patient and the visit was not anticipated in any case. A preliminary diagnosis was possible in 36 (78.2%). In most of the cases (33, 76%) no difficulties were reported by the physician, in 7 (16.3%) there were difficulties in communication, in 1 (2.3%) difficulty to get the history from a patient suffering from a psychiatric disorder. Socio-demographic characteristics, Information and communication technologies skills, face-to-face visit duration were not statistically different between the ‘ teletriagerheum ’ group (46 pts) and the group receiving regular first visit without ‘ teletriagerheum ’ service (52 pts). In the ‘ teletriagerheum ’ group, a lower number of blood exams (14% vs 46%, p&lt;0.005) and a lower number of instrumental exams (25% vs 45%, p=0.04) were prescribed during the face-to-face first visit; a higher percentage of definitive diagnosis (79% vs 67%, whilst not statistically significant p=0.2) and a lower number of patients requiring a visit before 6 months (26% vs 54%, p&lt;0.05) were observed compared to the group without teletriagerheum service. Conclusion These preliminary data showed that telemedicine for the first rheumatological visit was well-accepted by patients searching for rheumatology consultations and had the potential to be a tool for improving clinical diagnosis and rheumatological follow up in everyday clinical practice. A larger cohort will let us to further explore the potential benefits of telemedicine to improve accessibility to rheumatological services. References: - Disclosure of Interests None declared